Ugo Ehiogu, Tottenham Hotspur’s under-23 coach and former England and Aston Villa defender, passed away yesterday from cardiac arrest at the age of 44. Ehiogu collapsed at Spurs training ground in Enfield at 11:30am on April 20, where he received immediate medical treatment before being transferred to the hospital. A statement from the club confirmed that Ehiogu died in the early hours of Friday.

Ehiogu’s career as a centre-back spanned 20 years, with extensive spells at Aston Villa and Middlesbrough. He won four caps for England, scoring his only international goal in a friendly match against Spain at Villa Park, in 2001. He retired in 2009. Although he never played for Tottenham, he had been working at the North London club since 2014 as a youth team coach.

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Although the underlying case of Ehiogu’s sudden cardiac arrest is undisclosed at this point, it is likely another unfortunate example of the potential health complications that can affect former and current professional players. Sudden cardiac death in athletes, for instance, is commonly caused by hypertrophic cardiomyopathy, a genetic disease that causes the thickening of the myocardium, the heart’s muscle, making the heart pump blood more effectively.

Regular and intense physical activity is known to reduce the risk of heart complications, but it can play a detrimental role in athletes already suffering from underlying condition. A 2012 study in the Journal of Applied Physiology, showed a correlation between fibrosis – scarring of the heart — and ultra marathon running. This study corroborated earlier research, conducted with a cohort of former British Olympic endurance athletes, that also found a link between lifelong endurance exercise and heart scarring.

Heart disease is not the only health issue affecting former competitive players. The complications derived from repetitive traumatic head injuries in American Football players is well known. In 2015, a research paper by the Department of Veteran Affairs at Boston University found that 87 out of 91 former NFL players were affected by chronic traumatic encephalopathy, which leads to the accumulation of tau protein in the brain and can cause memory loss and dementia.

There is also a growing body of evidence showing a link between repetitive head trauma and cognitive impairment in football. Jeff Astle, a former England footballer in the sixties and the seventies recognised for his exceptional heading ability (he once compared heading a leather ball to heading a “bag of bricks”), was the first confirmed case of dementia caused by repetitive minor head trauma in football in 2002, when he died at the age of 59. In February 2017, a team of UCL neuroscientists reported the result of the autopsies of six former professional players, which concluded that all had suffered from Alzheimer’s.

Unfortunately, the list of possible health complication caused by a long career in sports isn’t limited to heart disease and brain trauma. A 2014 study by researchers from the University of Sao Paulo involving 100 former Brazilian professional football players, found that found that 78 per cent were overweight and 97 per cent suffered from chronic knee pain.